The biggest dismantling of Stewart in the spring of 2021 was the loss of over a stone in (over)weight, quite deliberately. Cathy wanted to go on a diet, and I went along with her, calorie counting. When I had come out of hospital I had weighed just over 12 stones, now after endless lockdowns I was back up to just over 13 stones. Something had to be done.
The diet was actually quite easy to keep to, as we were both helping each other out. Slowly but surely the weight came off. I had a target of getting under 12 stones, at which point I would treat myself to a lovely spicy curry with garlic fried rice and beer and wine. I hit 11st 13½lb on 13th June, just in time for my birthday treat the next day! The ultimate target weight is 11st 7lb.
I can’t say I was sorry to be a little further dismantled that May. Pathetic in comparison to my cancer treatments, my ingrown toenails were probably the most irritating thing that had gone wrong with me in all this time. Apart from that weird pyogenic granuloma. And my knee ligament injury. And that weird thumb thing. And the leaky bum that hurt a lot. And the leaky bladder that has been so inconsistent since late 2017. But apart from that, this was the most irritating thing.
They are all irritating. They can also be quite worrying as well. I suppose the good news about the ingrown toenails was that worry didn’t come into it. Impatience came into it instead. I played in one, just one, walking football session after lockdown was eased, and hated it because of the discomfort. I couldn’t play golf either, for the same reason.
Podiatry were onto it fairly quickly, but then got bogged down by oncology losing podiatry’s letter at the bottom of an in-tray. So through February, March, and April, nothing happened. Every day I checked the doormat for a letter giving me a date for the procedure; every day there was nothing. At the beginning of May I rang podiatry and was told I was on their “urgent list”.
On Tuesday 11th, frustration building, I rang them again using my most pathetic, pained voice. Suddenly: “Could you make it to the hospital tomorrow, there’s a spare one-hour slot?” Of course I could. So it was that Cathy and I spent a surprisingly happy hour and a quarter in a consulting room with a senior podiatrist, a podiatrist, and a student podiatrist. Once they had injected the local anaesthetic, which was a bit of a painful exercise, it was a doddle.
They took out a chunk of nail from my left toe that had been embedded deep in the flesh, and had been giving me all that grief, and they also trimmed back the right one as that nail was headed in the same direction of problematic-ness. Once the offending bits of nail were removed, they went on to do the phenolisation of the nail bed to stop those same offending bits of nail from re-growing. It’s a very caustic thing, is phenol, so it has to be applied very carefully, accurately, and sparingly.
The small bottle of phenol was carefully opened, as were three packs each of two wooden sticks – like kebab sticks, but with a cotton bud on one end. The pointy ends of a pair of them were dipped in the phenol, then stuck into the newly nail-less quick of my toes. They were literally stuck in there, pointing to the ceiling, making me look like an arrow-shot cowboy in a western, for exactly a minute before removal. Then the next pair of sticks was dipped and stuck. And finally the third set followed for their allotted minute.
And that was it, wrapped up in a pair of big fat dressings, my toes just about fitted through my open-toed sandals and we were off. It had been so easy. It got even better when we realised that parking fees had been suspended, presumably due to covid, and we had parked for free.
Cathy, being somewhat grisly in her outlook, asked if she could take the offending chunk of nail from my left foot home. She wanted to show it off to people, especially Hazel our foot-care professional who had referred me to Podiatry and was due to visit on Saturday. They found a small sample jar and Cathy popped it into that. As soon as we got home, my bandaged toes and a photo of the chunk of nail were all over Facebook and, I believe, Instagram. Hazel was suitably impressed.
Considering what they had done – cutting away a big chunk of toenail from each of my big toes, and then adding caustic phenol to the wound – it was remarkably easy on the pain threshold. All I needed the following day was a couple of paracetamol in the morning and again in the evening, and another one before I went to bed.
And on that following day I was off to the Practice Nurse at the GP surgery to have my dressings changed. That went very well, with very little blood on the previous day’s dressings. The one problem I had with it was when I accessed the NHS app a couple of days afterwards to see that my appointment had been recorded as a post-natal one. That came as a bit of a surprise to me, as I couldn’t remember giving birth recently. Which should have been fairly memorable, given that I was nearly 68 and male.
Within a week I was pretty well off the paracetamol. If you’re not in pain, why use painkillers? All right, I admit that occasionally it did get a bit “hmm”, but never “arrgh”, so why waste painkiller when I might need it for something else? I remember in hospital the nurses looking most disappointed whenever I refused a proffered painkiller.
I think pain management needs a bit of common sense really. If it’s a tolerable dull ache and not getting in the way of what I want to do, then ignore it. Pain is the body’s way of telling you that there’s something wrong. Well, in this case, I know exactly what’s wrong, and I know what I can and can’t do, and I know what to do about making it better. So as long as I can still do what I expect to do, that’s OK.
Every day the feet were soaked in a salt bath, and a fresh dressing applied. You could see that the basic wound bit where they’d cut the nail away was scabbing over nicely, but the phenol in the corners was still causing an open wound. The leaflet said it would take 8 to 10 weeks to heal fully, but the senior podiatrist had suggested that the pulses in my feet were so strong that I might get away with six weeks’ healing time. That phenol wound tells the story of why it takes so long to heal.
I tried walking around in shoes, even loose fitting ones, but basically a journey to the end of the garden to put kitchen waste in the compost bin was quite enough, thank you. So it was sandals and woolly socks for every trip out. Yes, I know, it is a truly inelegant look, but I wasn’t going to compromise comfort for fashion. However by early June, three weeks afterwards, I could just about last four hours gardening in loose trainers. But a trip to the supermarket in “proper” trainers proved uncomfortable after a few aisles.
All this toe action was getting in the way of my fitness and sporting enjoyment. After four weeks post-procedure, I felt confident enough to start doing some barefoot exercises in our conservatory. Needless to say, that was when the weather decided to get really hot. Really hot. And I was sweating more anyway as I neared the due date for my hormone jab. I hoped that the podiatrist’s feeling that I might heal in six weeks rather than eight to ten would be close to accurate. So I needed to get fitter to return to football and golf, never mind picking up on the gardening.
Then came my birthday week, and me and the hospital got slightly reacquainted. First of all, at the tender age of 68 and one day, I was back at MaxFax to have a look at the site of my pyogenic granuloma. It had developed into a bit if lump during January and February, and I had worried that it might be returning. However it stopped as just a lump.
The consultant had a quick look at it, and said that it was just scar tissue. Totally benign. They could dismantle it for me if I wanted them to. It’s there on my top lip, but I don’t struggle with it; it just sits there as another reminder of the life I’ve led, the wounds I’ve survived, and how whatever doesn’t kill you allegedly makes you stronger. I couldn’t see any point to having them take the scar tissue off, as when that procedure healed it would leave… yep, scar tissue. I politely declined his offer, apologised for wasting his time, and got signed off from MaxFax. No dismantling there then.
So that was Tuesday, next up at the hospital was Thursday and a fasting blood test. The earliest appointment they could offer me was 10.20, which meant I was going to be a very hungry boy when I got home, although the ongoing dieting helped manage the pangs. The reason for the bloods: the Oncology telephone appointment scheduled for the following Monday. Ah yes, my old friend prostate cancer. Hmm, I wonder how he’s doing.
Well, the Thursday bloods were taken on time, and I got home quickly so that I could get some breakfast down me. As soon as I’d set about the “fasting” bit the previous evening I’d felt hungry. Very hungry, in spite of just having eaten. Purely psychosomatic I suspect. Anyway, I didn’t die of starvation.
But back to the toes. On the Wednesday I had started to do my evening exercises as planned, but had had to stop after less than one complete set of reps due to discomfort in my left big toe. I put it down to having spent a good while gardening following earlier pushing my mum in her wheelchair around the supermarket. On Thursday I had stubbed my left big toe climbing some steps. A few weeks ago it would have been screamy sweary time. This time it was a simple, “oh, I’ve stubbed my toe; I need to be more careful”, and it was no more painful than it should be.
On Friday morning Cathy and I had a close look at things. Cathy got a magnifying glass and LED torch to study both toes in her best Sherlock Holmes style. The right one looks and feels as if it has completely healed, which is brilliant in just over 5 weeks. However the left one, the far deeper wound, still has a short line of fresh red tissue at its deepest point; it still has a bit of a way to go, but at least it isn’t tender any more. Whether the “six weeks” prediction will come to pass next Wednesday or not I don’t know (to be honest, I doubt it), but it certainly shouldn’t be much longer after that.
Before next Wednesday could come along, we had to have next Monday. That was Oncology telephone consultation day. She was a bit late ringing, and apologised, then explained that she had been talking about me with a colleague. My PSA was up a bit to 0.5, what to do? This meant that there were still active cancer cells lurking in there, which we’ve known all along. But now they’ve got a new toy to play with at Oncology: a PSMA PET-CT scan.
Apparently this can detect escaped prostate cancer cells in whatever part of the body they have snuck off to. But in order to get a clear indication of what might be happening they need to give the prostate a break from the assault it’s been enduring from the hormone treatment. So she wants me to come off the prostap and have another blood test in 12 weeks; depending on the results from that, they’ll either give or not give me a PSMA scan. Apparently this type of scan is nuclear, and is very much better at accurately detecting any metastases than previous scans. PSMA stands for “prostate-specific membrane antigens”.
In spite of my being on a diet to lose weight, all my bloods were good, with liver and kidney in good shape, and no signs at all of diabetes. Cholesterol could be a bit lower, but was more or less the same as always. Although she seemed quite positive about all this, for me it was another addition to the cancer-induced paranoia. Metastases = spread. Spread = anywhere. Anywhere = every ache or pain that I experience from now on!
Meanwhile, next Wednesday came along, and I am healed. It now seems that all of my strange afflictions are as healed as they’ll ever be. So while all these other weird and wonderful things have been going on in my medical world, and prostate cancer was just a background noise that I wasn’t paying much attention to, like a big bad penny it has suddenly reappeared and filled the void left by all the other problems being resolved.
I was kind of hoping that I could have a break from fresh medical procedures once all my wounds were healed. Yes, I know, prostap and regular bloods, monitoring for years and years like my uncle has had. But I suppose that’s the whole point of monitoring – is there something that needs doing, or something that could be done better? We’ll find out in about three months’ time.
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